Background: Pain is the most common presentation to the emergency department (ED). Pain is often poorly assessed and inappropriately treated. Research suggests that implementing a nurse-initiated analgesia policy will improve time to analgesia and patient satisfaction.
Objective: To determine the length of time taken for patients to receive analgesia, when presenting with pain.
Method: We collated other Victorian hospitals ED’s nurse-initiated medication policies to benchmark our practices against our colleagues. We conducted a review of the literature around timely access to analgesia. We conducted a retrospective data collection of 540 patients presenting to the ED with pain over a one-week period in 2019. We reviewed how long it took from triage to administration of analgesia.
Results: The majority of Victorian metropolitan ED’s have a nurse-initiated medication policy. These enable accredited emergency nurses to initiate nonsteroidal anti-inflammatory medications to opioids depending on the patient. Literature showed post implementation of a nurse-initiated analgesia policy, patients were receiving medications on average 70 minutes faster. Our data showed there is a significant delay for time to analgesia. Of the 540 patients, 250 received paracetamol a median 92 minutes from the time of triage. 121 received ibuprofen a median 107 minutes. 65 received other analgesia a median 95 minutes and 152 received opioids a median 110 minutes.
Conclusion: Through benchmarking ourselves against other Victorian ED’s it’s evident St Vincent’s isn’t operating currently to the same standard, as we do not have a nurse-initiated medication policy. Studies have shown that nurse-initiated policies are safe and beneficial.

Introduction: Sepsis is a leading cause of hospital mortality worldwide. The NSW Clinical Excellence Commission (CEC) implemented an evidence-based sepsis pathways across NSW in 2012 reducing time to treatment of adult and paediatric patients with sepsis. In 2019 a local audit of Emergency Department (ED) patients within one local health district reported suboptimal uptake of the sepsis pathways.

Aim: The aim of this study was to identify facilitators and barriers and tailor implementation strategies to optimise uptake of the CEC sepsis pathways.

Methods: Emergency nurses and doctors from four Australian EDs within one local health district were invited to participate in a virtual focus group to determine their perceptions of barriers and facilitators to the CEC sepsis pathways. Qualitative data were analysed using content analysis and categorised into domains of the theoretical domains framework. The Behaviour Change Wheel was used to identify and tailor interventions to address facilitators and barriers.

Results: Ten emergency doctors and 22 nurses participated in nine focus groups. Thirty-two facilitators and 58 barriers were identified corresponding to 11 TDF domains. Recommended implementation strategies included education, training, environmental restructuring, enablement, modelling, persuasion, and incentivisation. This informed the development of a revised implementation strategy comprising of an updated education and training program, sepsis champions, audit and feedback, development of electronic pathways, a communication plan and revision of local guidelines.

Conclusion: A range of factors influence uptake of the CEC sepsis pathways. A multi-modal tailored implementation approach is needed to address facilitators and barriers and optimise uptake.

Introduction
While recent literature has suggested that ambiguity of patient outcomes may contribute to the occupational distress of emergency nurses, data to substantiate this is lacking.
Aims
This research explores the if ambiguity about patient outcomes negatively impacts emergency nurses, and if ambiguity is demonstrated to cause this, the study will explore the frequency and scope of the impact on the personal and professional lives of emergency nurses.
Method
Emergency nurse participants were invited to complete a 17-item survey tool exploring their experience of ambiguity relating to patient outcomes and potential impact on their professional or personal life. Analysis of data collected from January – April 2023 was undertaken using descriptive statistical analysis.
Results
176 (93.1%) of participants responded that they sometimes, often, or always experienced ambiguity related to the clinical, social, or personal outcomes for a patient or their significant others after presentation to the emergency department. Similarly, a strong majority reported negative impacts of this ambiguity on their professional practice (n = 158, 85.4%) and/or personal life (n= 141, 75.8%)
Conclusions
A large majority of the study sample report ambiguity relating to the clinical, social, or personal outcomes of patients and/or their families after presenting to the emergency department (93.1%). Further, this ambiguity has a negative impact on the professional and personal lives of emergency nurses.
Significance
Ambiguity of patient outcomes has a significant impact on emergency nurses. Further study into this phenomena should be a priority of health services.

Introduction
Given the sudden nature of cardiac arrest and associated high mortality rates, family members may or may not wish to be present during cardiopulmonary resuscitation (CPR). Family presence during CPR may be inevitable, incidental or invited depending on context (out-of-hospital versus in-hospital).

Methods

This systematic review [1] (PROSPERO CRD42021242384) was reported according to PRISMA guidelines. The population was adults in cardiac arrest with family presence during CPR and outcomes were patient, family or provider outcomes. Three databases (Medline, CINAHL and EMBASE) were searched from inception to 10/05/2022. Risk of bias was assessed using the Mixed Method Appraisal Tool. The synthesis approach was guided by Synthesis Without Meta-Analysis reporting guidelines and a narrative synthesis.

Results
Thirty-one studies (of 9,459 citations) were included. The evidence was very low or low certainty. There is a lack of high-certainty evidence regarding the effect of family presence during CPR on patient outcomes. Family outcomes such as depression, anxiety, post-traumatic stress disorder (PTSD) symptoms, and experience of witnessing resuscitation were mixed. Providers had mixed experiences and resuscitation setting, provider education, and provider experience were all major influences on family presence during CPR. Providers reported that a family support person and organisational guidelines were important elements for facilitating family presence during CPR

Conclusion
There is variability in practices and outcomes of family presence during CPR. Future research should focus on testing interventions to reduce the individual decision burden, facilitate and operationalise care of families during adult resuscitation

Reference: https://doi.org/10.1016/j.resuscitation.2022.08.021

Background

Patients exhibiting behavioural disturbance in Emergency Departments (ED) present a risk to staff, patients and visitors and can interfere with the functioning of the ED. The need to train clinical staff in managing behavioural disturbances was identified at a tertiary hospital ED in Western Australia.

Aim

To develop a training program to improve staff confidence in managing behavioural disturbances in the ED.

Method.

The quality improvement project was conducted using a plan, do, study, act approach. A two-part training program, Emergency Management of Behavioural Disturbance (EMBeD), was developed based on high-fidelity eLearning and skill mastery. It involved professionally developed, interactive, video-based learning modules and a one-day course featuring simulated patient interactions using professional actors. The program was piloted by ED medical and nursing staff and evaluated using an online survey to measure participants’ confidence levels across seven domains of behavioural disturbance management. Quantitative and qualitative data were analysed for descriptive statistics and themes and will be used to inform program improvements.

Results

The pilot program was attended by 30 ED staff. A high confidence level was reported by participants (m=91.25% [83-96.6%]) following the EMBeD program, with participants reporting improved confidence across all domains. Provisional themes from open-ended questions were: ‘realism of actors’, ‘clinical relevance’ and ‘reflective practice’.

Conclusions

Early results indicate that the EMBeD program increases staff confidence in managing behavioural disturbances. Further research is required to confirm these results and measure the impact of the program on patient and staff safety.